Antimalarials in Lupus Nephritis

Secondary GNeasy

A 34-year-old woman with SLE and biopsy-proven Class V lupus nephritis asks about the role of hydroxychloroquine in her regimen. According to KDIGO 2024, what is the recommended use of antimalarials in patients with lupus nephritis?

  1. A.Antimalarials are not recommended because they provide no renal benefit
  2. B.Hydroxychloroquine is recommended for all patients unless contraindicatedCorrect
  3. C.Hydroxychloroquine is used only in combination with systemic glucocorticoids
  4. D.Hydroxychloroquine is reserved for patients with cutaneous lupus manifestations

Explanation

KDIGO 2024 recommends hydroxychloroquine (or an equivalent antimalarial) as background therapy for essentially all patients with lupus nephritis unless contraindicated. Benefits include reduced disease activity and flares, lower thrombotic and cardiovascular risk, favorable lipid and glucose effects, and improved long-term renal and overall survival. Its use is not limited to cutaneous disease or to combination with glucocorticoids. Baseline and periodic ophthalmologic screening is advised because of the risk of retinal toxicity.

Why each option

A.
Hydroxychloroquine has demonstrated renal and systemic benefits and is broadly recommended.
B.
Correct: recommended for all lupus nephritis patients unless contraindicated.
C.
It is background therapy and not restricted to co-administration with glucocorticoids.
D.
Benefits extend well beyond skin disease, including renal and cardiovascular protection.

Reference: KDIGO 2024 Clinical Practice Guideline for the Management of Lupus Nephritis, Kidney Int 2024;105(1S):S1-S69.

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